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HUILDING PERMIT APP7.ICATION � , � / / <br /> Applicant To Complete This Form �� �� , � <br /> If more than one Uuilding is to be conctructed, submiC a sepnrate permit ap- <br /> plication Sor cach tvilding. A eeparate perciit will be icsucd for each build- <br /> ing. <br /> Owner ���t N�l�ni�._��.' Auildin9 4ddress � //'L ��i�F..l-�.cY:_..A LAti�i... <br /> Address 330F! • Lr��hv Lot Olk. Sec. <br /> _�'—" <br /> City LvCiCtrr Phonei5� -�SYd Twp• A9e• ' <br /> Arohitect ' Subdivision (Plat) <br /> City Phone _ Metcs 6 Dounds (Unp].atted) <br /> Contraclor <br /> Address <br /> City Phone_ l3uilding Ucc <br /> State Licence Number' � � Deceribe Worl; Lo 6e Done <br /> Expiration Date _ _ <br /> Usc nf Duilding <br /> •� �,�� A�(1L� � U� �����' ��-New - Addition Repai ;Renodcl \ <br /> � �� �Q Fi`— l <br /> Valuation of Constructi,on � <br /> � (j. a o - <br /> � - �� Q�� PLOT YLAN _. <br /> rJ <br /> � Indi:�ate lo:. size, namc of streets, <br /> - indicatc location and tiidth of <br /> - allcya, loca::e proposed and all <br /> existin9 huildings, chow distcmces <br /> to property lines, show distances <br /> beta�ecn buildi.ngs. <br /> . Lot size�v�� U <br /> Lot arca S.Y. �, � <br /> uize of itldg. [l:!���i� E.F. � ' <br /> Number of Storics .E3�- 1_— <br /> Uasement �e:r � <br /> UEC LOOC_ TJ- � � ___ <br /> .�fL <br /> Signed .^.y <br /> Por- I <br /> Owner � <br /> DO NOT lvR?7'1: 6CIAW TIIIS 7.TNIi-I'OR CI7'Y USl: ONLY ' <br /> — --- � <br /> Datc Iieccived Firc 2onc <br /> F'lan Check Num6�r � _ Typc of. Construction I <br /> Valualion Occupancy Group <br /> Permit Fce Occop�nt Lo�d . <br /> Plan Check ['ce SprinH :ers Rcyuired <br /> 9'otal Fec puc <br /> Permit Nunil�cr <br /> Datc Issocd � <br /> APPROV[D �OR [3UILDING PCRMIT <br /> n,r� <br />